Patient-reported tobacco use integrated with EHR clinical decision support for lung cancer screening in primary care.

Abstract

687 Background: Lung cancer screening (LCS) rates are lower than other cancer screenings in part due to complex tobacco use eligibility criteria and lack of pack-year history documentation. Integration of clinical decision support (CDS) into the electronic health record (EHR) can optimize LCS across health care systems. The EHR can be configured to identify eligible individuals based on age and tobacco use history, triggering prompts for the primary care provider (PCP) at the point-of-care. This study aimed to: 1) Examine completion rates for the self-report tobacco use questionnaire, 2) Determine agreement between the self-report and EHR data, 3) Determine agreement in eligibility for LCS between the self-report and EHR data, and 4) Identify characteristics associated with self-report questionnaire completion. Methods: As part of a CDS toolkit, a tobacco use questionnaire was sent to eligible patients through the patient portal before their new or annual appointments in three primary care practices. The results of the questionnaire were automatically compared with the tobacco history in the EHR. PCPs received a notification about the results, any discrepancies and patient eligibility for lung cancer screening. Descriptive statistics, Clopper Pearson, Spearman correlations, Kappa statistics and logistic regression with 95% confidence levels were used for data analyses. Results: Out of 4640 patients that received the self-report questionnaire, 48.4% (n=2248) completed it. Among patients who reported their smoking status as current or former, pack-year history completion was 89.9% (n=736/820) vs. 77% (n=631/820) for the EHR, Spearman correlation 0.74. Percent agreement between self-report vs. EHR were 90.2% (n=1356/1504) for never, 82.1% (n=87/106) for current, and 88.6% (n= 613/692) for former smoking status, Kappa=0.78. Percent agreement between self-report vs. EHR eligibility for LCS based on age and tobacco use were 63.5% (n=66/104) and 91.3% (n=1958/2144) for not eligible, Kappa=0.71. Adults who were older (odds ratio (OR) per 10-year increase: 1.14 [1.06, 1.22]), white (white vs non-white OR: 1.73 [1.52, 1.98]), and treated in academic primary care settings (JC vs FH OR: 1.42 [1.25, 1.61]; SH vs FH OR: 2.64 [2.02, 3.46]) were more likely to complete the self-report questionnaire. Conclusions: The tobacco use questionnaire provided a higher pack-year history completion among self-identified current or former smokers and identified additional patients potentially eligible for LCS as compared with EHR data.